Mutual of Omaha presents Medicare Basics - PowerPoint PPT Presentation

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Mutual of Omaha presents Medicare Basics

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  1. Mutual of Omaha presents Medicare Basics Health products underwritten by Mutual of Omaha Insurance Company For Producer Use Only. Not for use with the general public.

  2. Why Mutual of Omaha? • A financially strong company with: -brand name recognition -quality products, excellent service and -committed to our community as demonstrated with our Wild Kingdom and sponsorship programs

  3. WhyMutual of Omaha? • A financially strong company since 1909 • Rated A+ (Superior) by A.M. Best • Second of 16, for financial strength and ability to meet contractual obligations

  4. Why Mutual of Omaha? • A provider of Medicare supplement insurance since 1966 • Mutual and United World paid $5.4 billion in Medicare supplement benefits* • Mutual and United World paid $780 million in Medicare supplement benefits in 2008 alone* • *Mutual of Omaha Actuarial Research, 2007

  5. Why Mutual of Omaha? • Our Medicare supplement rates are top in the industry • We have timely underwriting • We have a competitive compensation package • Offer world class travel with incentive trips • Purchase quality leads with our affordable lead program

  6. Top in the Industry • Ranked top three provider • Ranked 1st in agent sold Medicare supplement policies • Our earned premium has increased 42.2% in the last four years

  7. MedicareCoverage Medicare Coverage

  8. Medicare Coverage Medicare serves 44.1 million Americans • 36.9 million seniors • 7.2 million disabled persons • Average benefit per enrollee-$10,460 Source: “Medicare Fast Facts” National Committee to Preserve Social Security and Medicare

  9. Medicare - What is it? Medicare is a government regulated health insurance program that provides coverage to: • People age 65 and older • People who are disabled • People who are in permanent kidney failure • People who have ALS (Lou Gehrig’s disease)

  10. Medicare Eligibility-Part A A person is eligible for Part A at age 65* whether working or retired, if that person has been covered by Social Security long enough to qualify for benefits. * Some states allow coverage for individuals under age 65.

  11. Medicare Eligibility-Part A • A person who is under age 65 can get Part A benefits without paying premiums if he or she has received Social Security or Railroad Board disability benefits for 24 months. • People with ALS get Part A the month their disability benefits begin. • Persons, aged 65, who are not eligible under these conditions may enroll in Part A by paying the full cost.

  12. Medicare Enrollment-Part A Part A is premium-free for those who are eligible for Social Security or Railroad Retirement benefits.

  13. Medicare Enrollment-Part B • Everyone who is entitled to Part A is automatically enrolled in Part B, but may reject it. • There is a premium charge for Part B. • Participants are encouraged to purchase Part B because the federal government pays three-fourths of the premium cost.

  14. Initial Enrollment Period An individual may join Medicare: • No sooner than three months prior to the month of his or her 65th birthday. • During the month of his or her 65th birthday. • No later than three months after the month of his or her birthday. • Mutual extends the Medicare supplement enrollment period-adding three months to each period.

  15. Medicare Coverage Medicare is divided into two parts: • Part A—in-patient hospital insurance • Part B—supplemental medical insurance

  16. Medicare – Part A Part A provides in-patient hospital care • Pays for a portion of services in • hospitals, • skilled nursing facilities, • home health care and • hospice care • Doesn’t cover physician or medical services

  17. Covered Hospital Services Part A covered hospital services : • Room and board (semiprivate) • Operating and recovery room costs • Laboratory tests and x-rays • Drugs and medical supplies such as dressings • General nursing and rehabilitation services • Durable Medical Equipment • Blood Transfusions (after first three pints)

  18. Benefit Periods A benefit period: • begins the first day a person receives Medicare covered services in a hospital and • ends when the patient has been out of the hospital or skilled nursing facility for 60 days in a row.

  19. New Benefit Period • If a person enters a hospital again after 60 days, a new benefit period begins. • All Part A benefits (except for the lifetime reserve days) are renewed. • There is no limit to the number of benefit periods a person can have for hospital or skilled nursing facility care.

  20. Reserve Days • Hospital inpatient reserve days are a lifetime reserve of 60 days. • A reserve day can be used only one time. • Reserve days are not renewable for a second benefit period the way the first 90 days are.

  21. Inpatient Hospital Benefits • Inpatient Hospital Coverage - Part A • Participant pays $1,068.00 for first 60 days • The participant’s coinsurance is: • - $267 for days 61-90 • - $534 for days 91-150 (Lifetime Reserve) • -Full cost for days 151st and after (Medicare pays $0 cost)

  22. Skilled Nursing Facility Care • Medicare helps pay up to 100 days of care during a benefit period. • Medicare will pay benefits only if the skilled nursing facility(primarily provides skilled nursing and rehabilitation services)is certified by Medicare.

  23. Skilled Nursing Facility Care Skilled Nursing Care Services: • Semiprivate room and all meals • Regular nursing and rehabilitation services • Medications and medical supplies and appliances

  24. Skilled Nursing Facility Benefits Skilled Nursing Care Benefits • Participant’s Coinsurance is: - $0 for the first 20 days (Medicare pays 100%) - $133.50 a day for days 21-100 - 100% (Medicare pays 0% after day 100)

  25. Home HealthCare Services Covered home health care services when confinement is at home include: • Part-time nursing care • Physical, speech and occupational therapy • Medical social and home health aide services • Use of medical supplies and durable medical equipment There is no longer a requirement for hospitalization nor any maximum on the number of visits.

  26. Home Health Care Benefits To receive Medicare home health care benefits, an individual must meet four conditions: • A physician certifies the individual needs care at home and develops a plan of care. • The individual needs skilled nursing care or therapeutic nursing services. • The individual must be confined to home. • The agency must be Medicare approved.

  27. Home Health Care Benefits Home Health Care benefits: • Participant pays nothing except for durable medical equipment which is subject to a 20% coinsurance under Part B. Services must be provided by a Medicare certified home health agency. A home health agency is defined as a public or private agency that specializes in skilled nursing services and other therapeutic nursing services.

  28. Hospice Benefits-Part A Under certain conditions, Part A can pay for hospice care for terminally ill persons. Covered services include: • Physician services/Nursing care • Medical appliances and supplies • Outpatient drugs for pain relief • Short-term in-patient care • Counseling/therapies • Home health aide and homemaker services

  29. Hospice Benefits Hospice benefits are paid as follows: • Medicare pays 100% for covered services. • Participant pays: limited cost for outpatient drugs and inpatient respite care.

  30. Blood • Blood is covered under Medicare Part A and Part B. • When blood is required, participant pays for first three pints.

  31. Medicare – Part B Part Bcan help pay for: • Physician and surgeon services • Home health visits for patients requiring skilled care • Physical therapy and speech pathology services on an outpatient basis and on a limited basis in the patient’s home. • Miscellaneous medical services and supplies

  32. Medicare Part B Benefits • The Participant pays: • The Part B calendar year deductible -$135 • 20% of the Coinsurance

  33. Medicare Approved Charges • Medicare bases it payments on “reasonable charges.” • Medicare can pay only 80% of the approved charge, even if it is less than the actual charge. • For entities not taking “assignment” the Medicare beneficiary would pay any excess charges.

  34. Exclusions Medicare provides basic protection, it does not cover all of a person’s health care expenses. It does not pay for: • Services not reasonable, necessary or outside the U. S. • Personal comfort items and most immunizations • Cosmetic surgery, drugs or medicines taken at home (except for hospice) • Eye exams/Dental /Foot care/Hearing aids/Acupuncture • Private nurses • Custodial care/intermediate care/skilled care beyond 100 days a year.

  35. Medicare Supplements Medicare Supplement Insurance Plans

  36. Medicare Supplement Insurance Basic Things You Should Know: • Duplicate coverage is not allowed. • You are required to provide an outline of coverage and “Guide to Health Insurance for People with Medicare” to each Medicare client at the time of sale. • Policy must be delivered within 30 days from date of issue.

  37. Medicare Supplement Insurance • Private insurance subject to federal and state laws designed to help pay where Medicare does not pay • Standardized Plans A - J • Plan A is basic; Plan J has the most coverage • Plans B - J contain at least Plan A benefits • Two new plans- K and L

  38. Medicare Supplement-Basic Benefits Plans A-J must have five basic benefits: • Part A hospital co-insurance for 61-90 days in a benefit period. • Part A hospital co-insurance for lifetime reserve days 91-150. • Must pay eligible expenses for an additional 365 hospital days after Medicare benefits end. • Must pay 20% of Medicare approved expenses after the calendar year deductible is met. • Must all pay for the first three pints of blood (annually).

  39. Medicare Plans K and L Plans K and L: • Offer most of the same benefits as A-G • Have lower monthly premiums • Cost-sharing has set limits • Have higher co-payments • Provide no coverage for the Part B deductible • Have caps on out-of-pocket costs

  40. Medicare Plan K • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services • Covers 50% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met • Out-of-pocket limit increases each year for inflation

  41. Medicare Plan L • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services. • Covers 75% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met. • Out-of-pocket limit increases each year for inflation.

  42. Comparison of Plans C, K and L

  43. Medicare Supplement Plans Medicare Supplement Plans

  44. Medicare Supplement Plans Medicare Plans A – G • Part A deductible • Part A coinsurance • Lifetime reserve days • Additional 365 days • Skilled nursing facility care • Blood (first three pints)

  45. Medicare Supplement Plans Medicare Plans A – G • Part B deductible • Part B coinsurance • Emergency care outside the U.S. • Part B excess charges • At-home recovery • Basic drugs

  46. Mutual Care SELECT • Mutual Care SELECT contains a group of participating network hospitals. • Part A deductible is waived when services are received from participating network hospitals. • If services are received out of network, Part A deductible is not waived. • We will cover the cost of Part A deductible when Insured receives emergency services from a nonparticipating hospital.

  47. Mutual Care SELECT Plans B – G • Part A deductible • Part A coinsurance • Lifetime reserve days • Additional 365 lifetime reserve days

  48. Mutual Care SELECT Plans B – G • Skilled nursing facility care • Part B deductible • Part B coinsurance • Blood(first three pints)

  49. Mutual Care SELECT Plans B – G • At-home recovery • Part B excess charges • Emergency care outside the U.S. • Preventive care

  50. Underwriting Underwriting